Most skilled nursing facilities are lucky to have a visiting specialist a few times a year. But Tanner Mitchell has managed to partner with top area medical centers to bring gerontologists, cardiologists and medical residents to Brentwood Health Care Center on a regular basis.
"I want physicians to know we want to work closely with them and be a partner and an assistant to them in their plan of care," Mitchell says. "They know we're a facility that is friendly to research and friendly to trying new things. We'll always work with them for some sort of program to increase quality of life and outcomes for patients."
Brentwood, an independent for-profit 59-bed facility in Santa Monica, Calif., worked with Hong-Phuc T. Tran, MD, and Zaldy Tan, MD, geriatricians at the UCLA Medical Center Santa Monica. They were curious about resident depression levels. Over 16 months, more than 600 residents completed a PHQ-9 form to rate their satisfaction level at admittance and during their course of stay. If residents were unhappy, employees tried engaging with those residents. They also planned activities, such as visits from therapy animals, comedians, Motown producer Barry Gordy and the Los Angeles Laker Girls.
"We wanted to make sure they knew they weren't forgotten," Mitchell says. "When you get involved with residents and show you care about them, they respond. We want residents to be happy because we know residents who are happy get better faster."
Brentwood's nonmedical interventions worked, and Tran and Tan's research will be published in a peer-reviewed journal.
Data from CMS shows as of Jan. 17, Brentwood had no long-stay residents who are more depressed or anxious since they were last checked, compared to a state average of 1 percent and a national average of 6 percent. Brentwood also has lower than state and national averages for pain management, antipsychotic medication dosage, falls, incontinence and urinary tract infections. And behind each statistic is an initiative.
Mitchell worked with UCLA to be part of an infection control and prevention measures program that launched this month to make sure residents who enter with infections don't spread them and residents who enter without infection don't leave with one.
"A driving factor for a lot of things we're doing at Brentwood is to try and reduce readmissions, and we work closely with UCLA to do that," Mitchell says. The facility bought a bladder scanner to monitor urinary retention and help avoid hospital visits. The facility also bought an electrocardiogram at the advice of Shahram Naiem, MD, a cardiologist with UCLA Medical Center Santa Monica and St. John's Health Center. Naiem works with his patients—and consults any other Brentwood resident—to have smooth transitions to rehabilitate and complete dietary training and Brentwood to get EKG readings.
Mitchell’s relationships with local specialists have resulted in extraordinary access to services for residents. Brentwood has an in-house rehabilitation team—physical therapists, physical therapist aides, occupational therapists, certified occupational therapy assistants—who meet every Tuesday to review residents’ care plan. A wound nurse visits every day and a wound physician visits weekly. A psychologist visits weekly and a psychiatrist visits twice a month. A dentist and hygienist come visit at least quarterly. A podiatrist comes in as needed. All of these services are provided in an effort to minimize harm and maintain or improve resident health.
As a result of those efforts, Brentwood has cut the readmission rate in half from 24 percent in 2014 to 11 percent in 2015.
"It's paid off," Mitchell says. "We know we have had great outcomes from having these UCLA physicians in-house, communicating with them, doing some of these new programs and also having consistent, talented staff."
Some employees have been at Brentwood for decades, but before Mitchell arrived in November 2013, the staff had seen four administrators in three years. That was demoralizing, says nominator Craig Barron, who has been a consultant for Brentwood since 2007. When Mitchell arrived, he was ready to work. And, like the mark of any great leader, he wasn't going to take credit for the accolades.
"Obviously, he would not say, 'Well that was just me,'" Barron says. "He has a great team behind him, a tremendous director of nursing, but he's been able to pull it all together and had everyone see the vision for what he wants at his facility."
As Barron predicted, when we try to put the spotlight on Mitchell, he instead turns it on his staff, community partners and volunteers of Brentwood.
"I think honestly that's the reason I'm nominated because I was exposed to a lot of other pioneers," Mitchell says. "I don't consider myself a leader of tomorrow more than anyone else. The people I train and the people who trained me have an equivalent passion and rigor."
What's even more impressive is that this is Mitchell's first position in health care. Before that, Mitchell, 31, worked as a Congressional staffer, presidential campaign manager, missionary and sales associate at Nordstrom. It's all been part of his path toward healthcare with each experience teaching valuable skills along the way: managing others, affecting change, upholding beliefs and serving others. "It's all part of the tapestry," he says.